Medicare cuts hurt seniors

From the Worcester Telegram & Gazette, April 22, 2009

By Eric H. Schultz

There are good reasons why the Medicare Advantage program is so popular. It provides health care coverage that’s high quality and low cost.

Tip O’Neill famously said that all politics is local. That maxim is certainly true of the debate in the nation’s capital over Medicare that will affect tens of thousands of seniors in Central Massachusetts.

The debate concerns a proposal by the White House to reduce funding for Medicare health plans (known collectively as the Medicare Advantage program) and use those “savings” to help pay for health-care reform.

As in so many things, Massachusetts was a pioneer in the Medicare program when it was among the first states to offer a health-plan option to seniors. Approximately 190,000 Massachusetts seniors (about 20 percent of all residents on Medicare) are enrolled in the program — more than 43,300 in Worcester County.

There are good reasons why the Medicare Advantage program is so popular. It provides health-care coverage that’s high quality and low cost. In fact, the Massachusetts health plans that participate in the Medicare Advantage program have consistently ranked among the top health plans in the country by the National Committee for Quality Assurance for clinical quality and customer satisfaction. Medicare Advantage members typically have several plans to choose from, with varying premiums (Fallon Community Health Plan offers Medicare Advantage plans with a $0 premium). Medicare Advantage plans also have benefits and services that are not covered by traditional fee-for-service plans.

Perhaps the greatest benefit of Medicare Advantage — for both members and our entire health-care system is the program’s focus on coordination of care, which results in both reduced costs and improved quality and health outcomes. Studies show that on certain clinical quality measures, Massachusetts seniors enrolled in a Medicare Advantage plan receive better care than those in traditional fee-for-service plans.

Funding cuts will ultimately compromise the health and well-being of seniors enrolled in a Medicare Advantage plan. Their out-of-pocket costs are bound to increase, perhaps dramatically, putting a disproportionate and unfair burden on these seniors to pay for health-care reform. They are a population that can least afford it. According to statistics from the Henry J. Kaiser Family Foundation, most Medicare Advantage enrollees have incomes between $10,000 and $30,000.

But the financial impact won’t just be felt by seniors. There’s a hidden tax that awaits us all. Providers will face lower reimbursement for Medicare services.

To prevent care provided to seniors from being compromised, they will in turn need to recoup these reductions from employers and consumers with commercial insurance. According to a recently released study by Milliman Inc., one of the world’s largest independent actuarial firms, the annual health-care spending for an average family of four is already $1,788 higher due to low Medicare and Medicaid reimbursements. If we’re trying to make health care affordable, how will cutting back even more on funding Medicare Advantage plans help?

But this is not about our bottom lines. It’s about being able to continue to provide the type of care and services all patients need — particularly our most vulnerable residents — in an effective, cost-efficient manner. Let’s protect a program that’s providing value and working well for Central Massachusetts. Let’s not make the cure worse than the ill.

Eric H. Schultz is president and CEO of Fallon Community Health Plan. This was written in consultation with Dr. Jack M. Dutzar, president and CEO of Fallon Clinic, and John E. Smithhisler, president and CEO of St. Vincent Hospital.